Friday, December 10, 2004

Case Study based on Incident of Sexual Abuse in Orthodox Jewish Community

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From the Awareness Center Yahoogroup http://www.theawarenesscenter.org/networkinggroups.html(where we will be liberating materials from time to time).

Child Abuse and NeglectVol: 28 Issue: 3, March, 2004pp: 253-265

The social marketing approach: a way to increase reporting andtreatment of sexual assaultAmnon Boehma*, , Haya Itzhakyba. School of Social Work, University of Haifa, Mount Carmel, Haifa31905, Israelb. Department of Society and Welfare, School of Social Work, Bar-IlanUniversity, Ramat Gan , IsraelReceived 31 December 2002; revised 21 August 2003; accepted 27September 2003AbstractObjective: Too often communities remain silent in response to casesof sexual assault of children. Members of the community are afraid toreport such incidents and victims are reluctant to seek and accepttreatment. The purpose of the paper is to examine whether applicationof a social marketing approach may serve as an effective means formotivating communities to report and victims to seek professionaltreatment.

Methods: The paper is based on a case study of an ultra-orthodoxJewish community in Israel, where an informal campaign of silencedeveloped. Using content analysis of documents and in-depthinterviews, the research examines the implementation of a socialmarketing approach by a multidisciplinary team of professionals inthe community. It focuses on developments in the community´s attitudeto sexual abuse, especially with regard to reporting assault andseeking and accepting treatment.

Results: The findings show a considerable reduction in the fear thatvictims and other members of the community felt with regard toexposing the issue; a change among the community leaders, some ofwhom initially objected to reporting and treatment; introduction ofan alternative community dialogue that advocated reporting andtreatment; and a rise in the number of reports and of people intreatment.

Conclusion: The paper recommends the integration of principles ofsocial marketing in community programs aimed at dealing with sexualassault. In particular, it suggests the identification of competinggroups in the community, construction of specific programs fordifferent segments, addressing the no-monetary prices that the changemay incur on the different groups, location of appropriate places fordistribution of messages, and use of effective personal, as well aspublic means of communication and promotion.

1. IntroductionOne of the goals of professionals who deal with sexual assault ofchildren is to persuade victims, their families, and members of thecommunity as a whole to report incidents and to help victims, as wellas assailants, obtain treatment ( Bernard, 2002, Green, 2001,Hoult, 1998, Miller, 1991, Smith et al., 2000 ; Williams et al.,2002 ). This is particularly difficult in the case of sexual assaultbecause of the concern among victims, their families, the assailants,and the community as a whole that such exposure will lead tothe "mark of shame" often associated with involvement in such anincident ( Feiring et al., 2002 ; Ghetti et al., 2002 ; Kellogg &Hoffman, 1997, Roseler & Wind, 1994, Ulman, 1996 ). The assailants´apprehension about disclosure of their offences, and the concern ofcommunity members and leaders regarding the community image, oftenlead to an informal communication campaign to silence any discussionof the subject ( Dadia, 2002, Itzhaky & York, 2001 ). Manycommunities employ cultural and religious patterns and codes todefend this conspiracy of silence ( Alaggia, 2001, Farrell & Taylor,2000, Smith, 1994 ), and social-cultural networks have also beenfound to be significant factors in coping with the abusers and thesymptoms of the abused ( Muller et al., 2000 ; Onyskiw et al.,1999 ). In addition to the social-community aspect, silencing becomesa personal problem for victims, impairing and preventing theirrecovery ( Dadia, 2002, Donalek, 2001 ).

In light of this situation, it is of the utmost importance to findappropriate ways to counter the informal discourse and the sense ofshame and dishonor in the community. It is especially crucial to findmeans to motivate the target population to report such incidents andseek professional treatment. Although the literature on sexualassault usually describes this social problem and its undesirableconsequences, only few researchers have given due attention tocommunity approaches that deal with sexual abuse ( Barton et al.,1997 ; Itzhaky & York, 2001, Mulroy & Shay, 1997 ).

The purpose of the present research is to examine the implementationof the social marketing approach in dealing with a community thatsilenced the reporting of sexual abuse of children. This approach hasbeen found suitable for generating change in cases of destructive andnegative behavior patterns ( Andreasen, 1995 ; Donovan et al.,1999 ; Kotler & Roberto, 1989, McKenzie-Mohr, 2000, Rothschild,2000 ). Furthermore, it touches the very heart of the communitysocial problem that arises in the case of sexual assault—theemergence of informal communication networks, often accompanied byaggressive and violent measures, which threaten the victims anddissuade them from reporting and seeking treatment. The marketingapproach may provide victims and community members with a legitimateframework for alternative communication channels in the community,which actively counter the threats and facilitate reporting andtreatment.

Social marketing is an application of marketing approaches from thebusiness world to planning and management of social program thatconcentrates on changing attitudes, and especially, changing behaviorpatterns of different target groups, in order to improve the well-being of a community and society as a whole. Social marketingemphasizes several additional aspects: it is necessary to study thecommunity and target groups in depth in order to shape an optimalprogram; the development of strategy begins with the clients; and thesocial programs must be cost effective ( Andreasen, 1995, Andreasen,2001, Donovan et al., 1999 ; Frederiksen, 1984, Kotler & Roberto,1989 ). The planning process in marketing strategy includes two mainstages: segmentation of the target groups and planning acorresponding comprehensive marketing mix. Segmentation is a processby which more or less homogenous groups, each representing specificneeds, desires, and interests regarding change, are gathered togetherand differentiated from other groups. There are three commonapproaches to segmentation: (a) undifferentiated—addressing all thetarget groups with the same marketing mix; (b) differentiated—addressing several segments of the population with differentmarketing mixes, where the division into subgroups (segments) isbased on variables that differentiate the needs and desires of thedifferent groups in the population; and (c) focalized—addressing onesegment only with a marketing mix ( Boehm, 1998, Harvey, 1999,Sargeant, 1999 ).

The marketing mix is composed of elements, known as the four P´s:(social) product, place, price, and promotion ( Andreasen, 1995 ;Black et al., 2002 ; Fine, 1992, Rothschild, 2000 ; Slater et al.,2000 ), and is based on the distinct needs and desires of differentgroups in the population (market segments). In contrast to a concreteproduct, a social product involves adoption of social ideas, andparticularly, adoption of desired behaviors and/or cessation ofnegative behaviors (such as violence). In many cases, socialmarketing is initially directed at a change in attitudes, with theaim of later fostering change in behavior patterns. The element ofplace in the marketing mix focuses on decisions about how to beavailable to the target population. The price involved in adoptingthe new behavior pattern may be monetary, or it may be measured interms of time and energy invested by the target population, as wellas confusion or anxiety that may accompany the adoption of the newbehavior patterns. Finally, the promotion of social marketing isaimed at effective delivery of the message, in order to persuade thetarget population that the intended change is justified andworthwhile. Promotion efforts include (a) direct communication withthe target group (personal sale); (b) advertising in the mass media(in order to reach an especially broad target group); (c) publicrelations (such as distribution of posters and notices, meetings withkey figures, and special events) aimed at building a positive imageof the idea and the type of behavior recommended; and/or (d)incentives, to render the change worthwhile to the target group, orcounterbalance the cost involved.

2. MethodThis paper is based on a single case study. It describes an ultra-orthodox Jewish community in Israel, in which a campaign of silencingwas employed to bar the discussion and exposure of incidents ofsexual assault of children. It reviews a multidisciplinary communityintervention program, based on the social marketing approach, anddiscusses the results of the intervention. The authors have altereddetails and suppressed information that might disclose the identityof the community.

The case refers to a neighborhood of approximately 800 families, inan urban town in Israel. Most of the families are large, with anaverage of 4.8 children per family. The community is isolated, thefamilies have an average income level for Israel, and most workoutside of the town. There are elementary services in theneighborhood, such as a neighborhood grocery store and a smallcommunity center. A large portion of the neighborhood activityrevolves around the synagogue. The neighborhood local rabbi resideslocally and serves as the town´s formal leader. There are an activeneighborhood committee, a synagogue committee, a youth movementcommittee, a culture committee, and a sanitation and buildingcommittee. The children aged 9–17 are members of a youth movement.Neighborhood information is conveyed on a notice board, in neighbors´meetings, in announcements made in the synagogue, in a localnewspaper published by the neighborhood committee, and throughdissemination among residents.

a. Data collectionThe data collection process lasted a year. First, the planning,intervention, and resulting change were documented by the localcommunity worker and the action team that was set up to operate thecommunity marketing program. Second, existing material (a profile ofthe community prepared a few months prior to the intervention,minutes of committee meetings, and former intervention plans) werestudied. In addition, several in-depth interviews were held with 21participants (five social workers, four community leaders, sevenordinary citizens, three representatives of the victims´ families,and two representatives of the assailants´ families) over a period ofseveral months. The interviews were unstructured and were conductedby the "purposeful conversation" method ( Polkinghorne, 1989, Ronel& Humphreys, 1999 ), in which the interviewer and the respondentfreely discuss the subject of the interview. The purpose of theinterviews was to obtain a full description of the processes ofsilencing in the community, the marketing intervention (includinggoals, principles of operation, and process), and its results, asperceived by the social workers and the residents.

The content analysis included cross-checking the information derivedfrom different sources. The process comprised the following mainstages ( Neuman, 1994 ): preliminary reading of all the descriptivematerial to get a full sense of the process that took place in thecommunity following the incidents of sexual abuse; rereading andidentification of separate categories of meaning related to thedifferent aspects of the marketing approach; association of thedifferent categories to one another; and integration of the insightsgained, in order to produce a consistent description of the processthat took place in the community, the planning and implementation ofthe intervention, and the outcomes.

3. Case descriptiona. BackgroundA young teacher sexually assaulted three 14-year-old boys and thenthreatened to hurt them if they reported the incident. A week afterthe birth of his eldest son, the assailant approached the boys´parents and told them that he had "stumbled." He claimed, contrary tothe boys´ report, that he had only petted and hugged them, and hadnot touched their genitals. The assailant apologized and declaredthat after the birth of his son he understood what he had done andpromised it would not happen again. The parents congratulated him onthe birth of his son and, as they put it, "were pleased that he hadreturned to the straight path." A few weeks later, one of the victimsof the earlier assault attacked four 8-year-old boys (an incident offorced oral sex). One of the boys told his parents that his neighborhad hurt him. The parents tried to ascertain the nature of theinjury, but for a few weeks they refrained from reporting the assaultto the authorities. They asked the parents of the older boy not tolet him come near or talk to their son. However, when the incidentrecurred, the parents turned to the local rabbi for advice. The rabbialso spoke with the older boy and his parents and recommended sendinghim to a school out of town. The story became known to the communitysocial worker by chance.

b. The marketing strategyi. Developing a community marketing strategy teamThe community worker set up an action team comprised of three socialworkers—an additional community worker, an expert in sexual abuse,and an expert employed by the welfare services to work with at-riskteenagers. The team also included an educational psychologist, afamily therapist, and an educational counselor. It worked underexternal supervision of experts in the field of sexual assault,community practice, and social marketing. The team developed acommunity marketing program for dealing with the problem.

ii. Developing an informal campaignThe team members realized that the community had developed aninformal marketing campaign to silence any mention of the issue andprevent the involvement of professional institutions. There was clearevidence that under the pressure of the assailants´ families, a groupof religious leaders had emerged that used informal meetings in thecommunity to convey messages such as "disclosure and dealing with theissue are contrary to the religious commandments;" "exposure andtreatment of the subject will taint the reputation of assailants andvictims alike;" and "opening the subject for discussion and treatmentjeopardizes the chances of both assailants and victims to find amarriage partner and a proper career path." In addition, the leadersused informal meetings in the neighborhood to impose strict socialsupervision and in order to maintain a constant threat that anyonewho breached the messages risked ostracism from the group and thecommunity. It was clear that the dissemination of these messagesexceeded the bounds of mere gossip, and constituted a concertedeffort by an effective organization of public opinion agents, aimedat sowing fear and terror. Furthermore, as the work of the newprofessional community marketing team progressed, the informalcampaign in the community seemed to intensify.

iii. SegmentationThe professional team identified several interest groups: (a) 14additional victims, in different cases of sexual abuse over the last3 years, all of them boys (three were also suspected of sexualabuse), who expressed strong internal dissonance: on the one hand,they sought relief through discussion and appropriate therapy, and onthe other hand, they wanted to silence the case, for fear ofostracism by their peers and the community as a whole; (b) theassailants, who expressed fear of exclusion, a need for forgiveness,and, especially, a desire that the case be forgotten; (c) thefamilies of the victims, who feared that publicity and treatment ofthe issue would lead to community ostracism and future difficultiesin finding marriage partners for their sons; (d) the public as awhole, most of which was aware of the incidents, expressed a desirefor less public discourse, and wanted to avoid the involvement ofprofessionals, for fear that the publicity would harm the image ofthe community; and (e) the officeholders in the town, particularlythe rabbis, who expressed a strong desire not "to hang our dirtylaundry outside." They were concerned about a negative image of thereligious community, especially among people in other locations.

iv. General strategyThe members of the professional team developed a strategy based onseveral central decisions. The first was to employ bothdifferentiation and non-differentiation. Thus, the segmentationprocess indicated three main groups, defined in terms of theirattitude towards reporting and treatment: (a) the undecided, who werein conflict, and were mainly victims and their families; (b)opponents, especially among the assailants, their families, andseveral religious leaders; and (c) passive participants, who acceptedthe opinion of the religious authority, and chose silence. The teamdecided upon a strategy of differentiation, that is, application ofdifferent approaches, in the first two groups—the undecided and theopponents—as both were active and both had influence on thoseaffected by the problem, and an undifferentiated approach in allthree groups. The decision to apply both differentiation and non-differentiation—contrary to focalization—was necessary in order topenetrate various specific groups and at the same time to reach thecommunity as a whole.

Second, the team decided to focus on a strategy of education andinformation. The aim was to impart a new set of values and norms thatadvocated reporting and treatment, contrary to the values and normsthat had developed in the community over the years, which called forsilence with regard to sexual abuse. In the same spirit, the teamchose to refrain, at least at this stage of intervention, from harshpunishment of the assailants, in order to avoid an intensifiedreaction from the rival group.

Third, the team members reached the conclusion that the success oftheir plan depended upon an effective persuasive alternative thatwould create a clear preference over the informal activities againsta change of the patterns of silence. The question arose whether itwas desirable, similar to the existing discourse in the community, towork together with informal agents of change, discretely, or in aformal, public framework. Despite the great difficulty of raising theproblem for public discussion, especially in an ultra-orthodox Jewishcommunity, the team members decided that formality and publicitycould give the marketing system particularly strong impact. First, aformal and open system would broadcast a higher level of authority.Second, a formal and open system would be consistent with the messagethat the team members wanted to convey—that the problem should not besilenced and should be treated.

v. The social productThe team defined several social ideas (attitudes, perceptions, andbeliefs) that should be reinforced: (a) acknowledgment that it isnecessary and possible to prevent sexual abuse; (b) perception ofthose assaulted as victims and not guilty; (c) recognition that beinga victim of sexual abuse is not a disgrace that interferes withdeveloping a personal career, marriage, and the like; (d) a generalview that professional therapy does not contradict Jewish religiousvalues but is actually consistent with them; and similarly; (e) anunderstanding that reporting is like fulfilling a religious moralduty; as well as (f) recognition that proper professional care forvictims and assailants can help and also improve a community´s image.

The team also defined several patterns of action and behavior thatshould be advocated: (a) opening channels for discussion of thesubject among professional and religious people; (b) public supportof the formal and informal leadership; (c) increased reporting ofcases of sexual assault; (d) agreement of victims, their families,and assailants to receive professional therapy; and (e) reduction ofthe number of victims.

vi. PlaceIn correspondence with the general strategy, it was decided to employtwo approaches to the place of the social marketing activity. Thefirst was to convey messages at central locations—synagogues andschools—in order to imbue the activity with a religious andeducational character. The second was reaching out, in family homesand small groups. The aims were to enable discussion of the subjectaccording to the special needs of each group, to facilitatedevelopment of a dialogue, and to allow direct countering of messagesthat might emerge from the competing group.

vii. PriceThe team came to the conclusion that the most significant price themembers of the community (of different groups) were liable to pay foradopting the ideas and expected behavior patterns was the risk ofa "mark of shame." Specifically, they were concerned that the "stain"of being a victim of sexual abuse would make it difficult to find amarriage partner, and that those reported and treated were liable tojeopardize their status in the community and risk ostracism, as wellas the image of the community as a whole. Therefore, in addition tocreating a communication network that supported treatment, themarketing team also undertook to watch and protect those who "brokethe silence."

viii. Means of promotionThe team decided to focus on three means of promotion: publicrelations, advertising, and direct communication. A decision was madeto recruit local rabbis as the central agents of public relations.This choice was based on their status and authority as judges (adecision pronounced by a rabbi is like a legal verdict). The teammembers agreed that an open discussion in a synagogue could serve asa very powerful basis for changing attitudes and behavior patterns inthe community. In addition, in order to reinforce the messages andenhance their influence, they advertised the message on localtelevision and in newspapers. The team also recruited additionalsocial workers, psychologists, educational counselors, and teachers,to enable direct discussion with members of the community, familiesof victims, assailants, and other families.

c. Process and resultsAttempts were made to recruit the local rabbi, with limited success.In a meeting with him, the social workers focused on the moralproblem of silencing abuse. They suggested that failure to supportthe victims could cause them further damage. Moreover, resistance tointervention and change might be interpreted as a legitimization—orat least acceptance—of sexual abuse.

However, the local rabbi was not totally convinced, and they tried tosolicit the assistance of an influential rabbi from outside theneighborhood. This rabbi agreed to speak with the local clergyman,and convinced him to address the subject in his Sabbath sermon (whichwas attended regularly by most of the residents). Indeed, the localrabbi did warn the congregation that "there are evil spirits incommunity and they need to be stopped." However, his message was toovague, falling short of a specific directive.

Realizing that this was the most they could expect from the localrabbi, the social workers turned again to the rabbi from outside thecommunity, who agreed to appear before the residents himself.Speaking to a full house, the guest rabbi used biblical texts andreligious teachings to discuss the important role of professionals inintervening with sexual abuse. Addressing the community aspect, hetold the residents that turning a blind eye to the first incident hadresulted in a chain reaction, with additional victims. He insistedthat by religious law, such a victim was allowed to marry any woman,and it was forbidden for the community to single such people out.This time, the message condoning reporting and professional treatmenthad been delivered clearly.

The local rabbi then joined the professional team, which beganoperating more directly and intensively in the community. However, atthis stage the resistance increased as well. Employing their powerand status, the family of one of the boys persuaded neighbors andother residents not to cooperate. Although they had some success, theinvolvement of the local rabbi helped counter the family´s impact. Atthe same time, the members of the professional team concentrated onhelping the families of the victims and working with the children.

The team also worked with the youth movement counselors and theteaching staff at the school on the subject of sex education. Thelocal rabbi later joined this effort and spoke with the children andteenagers about boundaries, the roles and responsibilities of theindividual and society, relations between boys and girls, and thelike.

When word reached the multidisciplinary team that rival groups weredeveloping in the community, the community worker took action byworking with the different local youth groups and visiting differentextracurricular activities in the community center. To elaborate andunderscore the message, she used different techniques, such asparticipatory video and drama games. She also spoke with groups ofadults (women, active citizens, parents whose children were notvictims, and others), reinforcing the message that it is forbidden toostracize victims and their relatives or to portray them as guilty.

At the end of the intervention, several outcomes were evident:

Workers in the local welfare department indicated that the marketingand treatment process had reduced the fear of reporting and exposureamong victims and other residents. This was expressed in a notablerise in the number of reports, as well as a growing number of victimsand assailants receiving treatment.The rabbi, who initially opposed exposure, joined the team andcontributed to its activity.The argument between groups within the community regarding the needto expose and deal with sexual assault ended. In order to establishformal legitimacy, the residents suggested a democratic vote in aresidents´ meeting on the need for exposure. Ninety percent of theneighborhood residents voted in favor of exposure. They alsosupported treatment for the victims, the assailants, and thecommunity as a whole.The victims and their families began a process of group andindividual therapy. Their status was maintained, and the victims didnot become the accused, as was initially feared.Regarding the assailants, the community discussed the question ofwhether to file a complaint with the police or treat the assailants,most of whom were victims of sexual abuse themselves. At the time ofthe research, they had not reached a conclusion. It should be notedthat before the intervention, such a discussion would never have beenheld publicly.

4. DiscussionThe present research corroborates earlier findings ( Alaggia, 2001,Dadia, 2002, Farrell & Taylor, 2000, Itzhaky & York, 2001, Smith,1994 ) that in many cases of sexual assault an informal communitynetwork emerges that supports silencing the issue and preventingreports and professional treatment. Moreover, the opponents ofreporting and treatment often use cultural or religious codes inorder to convey messages in favor of silence. Therefore, in order toencourage the victims, their families, and the community as a wholeto report and deal with sexual abuse, a fitting community strategywas needed that would concentrate on changing the attitudes thathindered reporting. Thus, the purpose of the present research was toinvestigate whether an intervention plan based on the socialmarketing approach and focused on changing attitudes and behaviorpatterns of multiple community groups ( Andreasen, 1995, Kotler &Roberto, 1989, Rothschild, 2000 ) would succeed in increasing thepatterns of reporting and treatment of cases of sexual abuse.

The research findings show that the resistance to reporting andtreatment by the majority of the community was linked to obedienceand "placation," that is, an effort to avoid social pressure andstigmatization by refraining from breaking community rules and norms.Sometimes, the resistance was associated with leaders with religiousauthority. However, the resistance to reporting and treatment was notusually based on a moral notion that was fully integrated in thepersonal value system of the members of the community. One of theprominent findings in the study of this community was that differentgroups, victims and others, vacillated between silence and exposureregarding the assault, and they supported silence (actively orpassively) for external motives.

Implementation of the marketing approach helped empower the membersof the community. Through the marketing approach, the children whowere attacked and their families increased their critical awarenessof the sources of their oppression. They refused to accept the guiltcast upon them, adopted an approach integrated with their personalvalue system, and took action to report and to seek or accepttreatment as part of their internalization of the message and innercontrol, without placating or identifying with external factors.

In the first stages of implementation of the marketing approach, anexternal object of identification—the rabbi—was used. However, intime, after personal discussions with the social workers,psychologists, and educators, most of the members of the communitytook action to report and supported treatment independently, out ofrecognition of the importance of responding to personal needs. Theresearch findings, then, support adoption of the social marketingapproach in dealing with cases where sexual abuse of children issilenced. In the view of the authors, the advantages of the socialmarketing approach revealed in this study may serve as a basis forpractice and research regarding additional social issues, when it isnecessary to change a harmful behavior pattern in the face ofcommunity organization characterized by a conspiracy of silence.Examples of such issues are domestic violence, violence in thecommunity and the school, and drug or alcohol abuse among adults orchildren.

The experience in this case study highlights several aspects of themarketing approach that may be particularly beneficial whenincorporated in community programs for dealing with sexual abuse.

a. Interdisciplinary teamwork and resident participationThe application of social marketing, a relatively new approach indealing professionally with sexual assault, may give rise to newethical dilemmas. The central issue is related to the goal of socialmarketing methods and techniques, namely, to generate change inattitudes and behavior. In particular, the question is, who shoulddetermine the desired attitudes and behaviors—experts in socialmarketing, professionals, or members and representatives of thecommunity?

For both ethical and practical reasons, all these parties should beinvolved in setting the goals for such a process. In order to ensureresident participation, the authors suggest that interdisciplinaryteams of local care providers work together with key members of thecommunity. Consideration of local codes and norms is essential in anyeffort to generate a grassroots process of change, as in the casedescribed.

While professionals from outside the community may contributeknowledge and skill for applying the social marketing approach, theinclusion of professionals from the community, who are familiar withthe local culture, is essential. However, the inclusion of laycitizens as team members in the early stages of forming the team mustbe considered with due caution, in light of potential resistance fromdifferent groups in the community. Nevertheless, a program thatrelies upon an in-depth study of the needs and desires of the clientsand the participation of community representatives as early aspossible helps empower community members and facilitates efforts torecruit support for the program.

b. Customizing the intervention program for different groupsThe findings indicate that intervention regarding the issue ofsilencing requires a differential approach, corresponding todifferent groups, particularly the supporters of silence, theundecided, and the apathetic. Understanding the different needs andinterests of each group, as well as the opposing and supportingattitudes, and deciding on a segmentation strategy contributedsubstantially to preparation of a program tailored to each group.Indeed, the non-differentiation segmentation was found useful foraddressing the community as whole, while differentiation segmentationwas necessary to reach specific groups. This combination ensuredcomprehensive distribution of the messages. A community program thataspires to economize on resources and provide a uniform answer forall groups, without consideration of the different interests of each,is liable to miss the mark.

c. Recognition of priceThe research findings suggest that change in patterns is stronglylinked to the price that the community members expect to pay for thechange. In this case, the price of giving up silence was notmonetary, but was related to investment of time and effort and,particularly, the risk to each group of disgrace or ostracism. Thecommunity members had an alternative to the proposed change: theycould have continued their passive approach and refrained fromexposing the issue, without taking risks. Therefore, an effectivemarketing program must take into account not only the goal ofincreasing patterns of reporting and treatment, but—and perhapsmainly—how to relieve the members of the community from the heavycosts involved in the transition to a new behavior pattern (in ourexample, by legitimizing the patterns of reporting and treatment).

d. Facing competitionThe findings also indicate that in order to reduce the price ofchange, the social marketing system must consider competing forces.The success of the intervention described here can be attributedlargely to the combination of direct mass dissemination of themessages with reaching out and personal discussions. Directpresentation (from the rabbi´s pulpit and in the local press) imbuedthe messages advocating reporting and treatment with legitimacy,authority, and power. The reaching out and personal conversationswith different groups in the community made it possible to learnabout specific needs and interests and, in the course of thedialogue, to respond accordingly.

This approach had a clear advantage over the "competition." While thesilencing campaign was, by nature, conducted discretely and almostexclusively in informal systems, the social marketing system workedin this arena as well as developing open, legitimate channels. It canbe argued that this combination was critical to the success of thecommunity program. The simultaneous use of both informal and formalchannels made it possible to remove the threat felt by the members ofthe community, and at the same time to project a new message.

e. Gradual transitionAnother contribution of the social marketing approach that isdemonstrated by this case is that it generates a gradual process ofchange. Marketing campaigns begin by arousing interest in theproposed alternative (here, the idea of reporting and treatmentinstead of silencing). When members of the community consider the newbehavior patterns suggested to them, the marketing campaign turns toclarifying the meaning of the change and highlighting its advantages(for instance, by supporting and encouraging those that report andseek treatment). However, particularly in the initial stages of thecampaign, there may be apprehension, deliberations, and evenresistance in the target population. Therefore, it is necessary tomaintain constant encouragement and support, so that the pattern ofreporting and treatment is assimilated and adopted consistently.

(continued)c. Process and resultsAttempts were made to recruit the local rabbi, with limited success.In a meeting with him, the social workers focused on the moralproblem of silencing abuse. They suggested that failure to supportthe victims could cause them further damage. Moreover, resistance tointervention and change might be interpreted as a legitimization—orat least acceptance—of sexual abuse.

However, the local rabbi was not totally convinced, and they tried tosolicit the assistance of an influential rabbi from outside theneighborhood. This rabbi agreed to speak with the local clergyman,and convinced him to address the subject in his Sabbath sermon (whichwas attended regularly by most of the residents). Indeed, the localrabbi did warn the congregation that "there are evil spirits incommunity and they need to be stopped." However, his message was toovague, falling short of a specific directive.

Realizing that this was the most they could expect from the localrabbi, the social workers turned again to the rabbi from outside thecommunity, who agreed to appear before the residents himself.Speaking to a full house, the guest rabbi used biblical texts andreligious teachings to discuss the important role of professionals inintervening with sexual abuse. Addressing the community aspect, hetold the residents that turning a blind eye to the first incident hadresulted in a chain reaction, with additional victims. He insistedthat by religious law, such a victim was allowed to marry any woman,and it was forbidden for the community to single such people out.This time, the message condoning reporting and professional treatmenthad been delivered clearly.

The local rabbi then joined the professional team, which beganoperating more directly and intensively in the community. However, atthis stage the resistance increased as well. Employing their powerand status, the family of one of the boys persuaded neighbors andother residents not to cooperate. Although they had some success, theinvolvement of the local rabbi helped counter the family´s impact. Atthe same time, the members of the professional team concentrated onhelping the families of the victims and working with the children.

The team also worked with the youth movement counselors and theteaching staff at the school on the subject of sex education. Thelocal rabbi later joined this effort and spoke with the children andteenagers about boundaries, the roles and responsibilities of theindividual and society, relations between boys and girls, and thelike.

When word reached the multidisciplinary team that rival groups weredeveloping in the community, the community worker took action byworking with the different local youth groups and visiting differentextracurricular activities in the community center. To elaborate andunderscore the message, she used different techniques, such asparticipatory video and drama games. She also spoke with groups ofadults (women, active citizens, parents whose children were notvictims, and others), reinforcing the message that it is forbidden toostracize victims and their relatives or to portray them as guilty.

At the end of the intervention, several outcomes were evident:

Workers in the local welfare department indicated that the marketingand treatment process had reduced the fear of reporting and exposureamong victims and other residents. This was expressed in a notablerise in the number of reports, as well as a growing number of victimsand assailants receiving treatment.The rabbi, who initially opposed exposure, joined the team andcontributed to its activity.The argument between groups within the community regarding the needto expose and deal with sexual assault ended. In order to establishformal legitimacy, the residents suggested a democratic vote in aresidents´ meeting on the need for exposure. Ninety percent of theneighborhood residents voted in favor of exposure. They alsosupported treatment for the victims, the assailants, and thecommunity as a whole.The victims and their families began a process of group andindividual therapy. Their status was maintained, and the victims didnot become the accused, as was initially feared.Regarding the assailants, the community discussed the question ofwhether to file a complaint with the police or treat the assailants,most of whom were victims of sexual abuse themselves. At the time ofthe research, they had not reached a conclusion. It should be notedthat before the intervention, such a discussion would never have beenheld publicly.

4. DiscussionThe present research corroborates earlier findings ( Alaggia, 2001,Dadia, 2002, Farrell & Taylor, 2000, Itzhaky & York, 2001, Smith,1994 ) that in many cases of sexual assault an informal communitynetwork emerges that supports silencing the issue and preventingreports and professional treatment. Moreover, the opponents ofreporting and treatment often use cultural or religious codes inorder to convey messages in favor of silence. Therefore, in order toencourage the victims, their families, and the community as a wholeto report and deal with sexual abuse, a fitting community strategywas needed that would concentrate on changing the attitudes thathindered reporting. Thus, the purpose of the present research was toinvestigate whether an intervention plan based on the socialmarketing approach and focused on changing attitudes and behaviorpatterns of multiple community groups ( Andreasen, 1995, Kotler &Roberto, 1989, Rothschild, 2000 ) would succeed in increasing thepatterns of reporting and treatment of cases of sexual abuse.

The research findings show that the resistance to reporting andtreatment by the majority of the community was linked to obedienceand "placation," that is, an effort to avoid social pressure andstigmatization by refraining from breaking community rules and norms.Sometimes, the resistance was associated with leaders with religiousauthority. However, the resistance to reporting and treatment was notusually based on a moral notion that was fully integrated in thepersonal value system of the members of the community. One of theprominent findings in the study of this community was that differentgroups, victims and others, vacillated between silence and exposureregarding the assault, and they supported silence (actively orpassively) for external motives.

Implementation of the marketing approach helped empower the membersof the community. Through the marketing approach, the children whowere attacked and their families increased their critical awarenessof the sources of their oppression. They refused to accept the guiltcast upon them, adopted an approach integrated with their personalvalue system, and took action to report and to seek or accepttreatment as part of their internalization of the message and innercontrol, without placating or identifying with external factors.

In the first stages of implementation of the marketing approach, anexternal object of identification—the rabbi—was used. However, intime, after personal discussions with the social workers,psychologists, and educators, most of the members of the communitytook action to report and supported treatment independently, out ofrecognition of the importance of responding to personal needs. Theresearch findings, then, support adoption of the social marketingapproach in dealing with cases where sexual abuse of children issilenced. In the view of the authors, the advantages of the socialmarketing approach revealed in this study may serve as a basis forpractice and research regarding additional social issues, when it isnecessary to change a harmful behavior pattern in the face ofcommunity organization characterized by a conspiracy of silence.Examples of such issues are domestic violence, violence in thecommunity and the school, and drug or alcohol abuse among adults orchildren.

The experience in this case study highlights several aspects of themarketing approach that may be particularly beneficial whenincorporated in community programs for dealing with sexual abuse.

a. Interdisciplinary teamwork and resident participationThe application of social marketing, a relatively new approach indealing professionally with sexual assault, may give rise to newethical dilemmas. The central issue is related to the goal of socialmarketing methods and techniques, namely, to generate change inattitudes and behavior. In particular, the question is, who shoulddetermine the desired attitudes and behaviors—experts in socialmarketing, professionals, or members and representatives of thecommunity?

For both ethical and practical reasons, all these parties should beinvolved in setting the goals for such a process. In order to ensureresident participation, the authors suggest that interdisciplinaryteams of local care providers work together with key members of thecommunity. Consideration of local codes and norms is essential in anyeffort to generate a grassroots process of change, as in the casedescribed.

While professionals from outside the community may contributeknowledge and skill for applying the social marketing approach, theinclusion of professionals from the community, who are familiar withthe local culture, is essential. However, the inclusion of laycitizens as team members in the early stages of forming the team mustbe considered with due caution, in light of potential resistance fromdifferent groups in the community. Nevertheless, a program thatrelies upon an in-depth study of the needs and desires of the clientsand the participation of community representatives as early aspossible helps empower community members and facilitates efforts torecruit support for the program.

b. Customizing the intervention program for different groupsThe findings indicate that intervention regarding the issue ofsilencing requires a differential approach, corresponding todifferent groups, particularly the supporters of silence, theundecided, and the apathetic. Understanding the different needs andinterests of each group, as well as the opposing and supportingattitudes, and deciding on a segmentation strategy contributedsubstantially to preparation of a program tailored to each group.Indeed, the non-differentiation segmentation was found useful foraddressing the community as whole, while differentiation segmentationwas necessary to reach specific groups. This combination ensuredcomprehensive distribution of the messages. A community program thataspires to economize on resources and provide a uniform answer forall groups, without consideration of the different interests of each,is liable to miss the mark.

c. Recognition of priceThe research findings suggest that change in patterns is stronglylinked to the price that the community members expect to pay for thechange. In this case, the price of giving up silence was notmonetary, but was related to investment of time and effort and,particularly, the risk to each group of disgrace or ostracism. Thecommunity members had an alternative to the proposed change: theycould have continued their passive approach and refrained fromexposing the issue, without taking risks. Therefore, an effectivemarketing program must take into account not only the goal ofincreasing patterns of reporting and treatment, but—and perhapsmainly—how to relieve the members of the community from the heavycosts involved in the transition to a new behavior pattern (in ourexample, by legitimizing the patterns of reporting and treatment).

d. Facing competitionThe findings also indicate that in order to reduce the price ofchange, the social marketing system must consider competing forces.The success of the intervention described here can be attributedlargely to the combination of direct mass dissemination of themessages with reaching out and personal discussions. Directpresentation (from the rabbi´s pulpit and in the local press) imbuedthe messages advocating reporting and treatment with legitimacy,authority, and power. The reaching out and personal conversationswith different groups in the community made it possible to learnabout specific needs and interests and, in the course of thedialogue, to respond accordingly.

This approach had a clear advantage over the "competition." While thesilencing campaign was, by nature, conducted discretely and almostexclusively in informal systems, the social marketing system workedin this arena as well as developing open, legitimate channels. It canbe argued that this combination was critical to the success of thecommunity program. The simultaneous use of both informal and formalchannels made it possible to remove the threat felt by the members ofthe community, and at the same time to project a new message.

e. Gradual transitionAnother contribution of the social marketing approach that isdemonstrated by this case is that it generates a gradual process ofchange. Marketing campaigns begin by arousing interest in theproposed alternative (here, the idea of reporting and treatmentinstead of silencing). When members of the community consider the newbehavior patterns suggested to them, the marketing campaign turns toclarifying the meaning of the change and highlighting its advantages(for instance, by supporting and encouraging those that report andseek treatment). However, particularly in the initial stages of thecampaign, there may be apprehension, deliberations, and evenresistance in the target population. Therefore, it is necessary tomaintain constant encouragement and support, so that the pattern ofreporting and treatment is assimilated and adopted consistently.

The researchers seem to have underestimated the importance of the outside Rabbi's support. It is doubtful that their methodology was really the critical success factor, instead it was the willingness of one Rabbi to have the courage to stand up and tell the truth. Hmmm maybe this is the real lesson. We just don't have enough orthodox Jewish leaders who are willing to speak the truth and stand up for what is right. Instead we are mired in the dribble of ethnocentric thinking... Overall, interesting study though.. I would have loved to have listened in as a couple of social workers tried to reason with the Rabbi :-) Avi...